Vital Signs: Risk for Overdose from Methadone Used for Pain Relief — United States, 1999–2010

Leonard J. Paulozzi, MD; Karin A. Mack, PhD; Christopher M. Jones, PharmD


Morbidity and Mortality Weekly Report. 2012;61(26):493-497. 

In This Article


For this report, national death rates during 1999–2009 are based on the National Vital Statistics System multiple cause of death files.[9] Methadone-related deaths were defined as those with an underlying cause of death classified by the International Classification of Diseases, 10th Revision (ICD-10) external cause of injury codes as X40-X44, X60-X64, X85, or Y10-Y14 and an ICD-10 code (T40.3) for methadone poisoning. Methadone might have been listed alone or in combination with other drugs.

The amounts of opioid pain relievers distributed for 1999–2010 nationally and by state were obtained from the DEA's Automation of Reports and Consolidated Orders System (ARCOS).* Distributions of methadone to opioid treatment programs were not included. Annual numbers of prescriptions dispensed for methadone and other opioids in outpatient settings for 1999–2009 came from an analysis conducted by FDA in 2010 using a commercial prescription and patient measurement service (Vector One: National [VONA]) that can estimate the number of prescriptions for drugs dispensed by outpatient retail pharmacies in the United States.[10]

Population-based counts of drug-related deaths for methadone and other opioids in 2009 came from 13 states in the Medical Examiner component of the Drug Abuse Warning Network (DAWN): Delaware, Massachusetts, Maryland, Maine, New Hampshire, New Mexico, Oklahoma, Oregon, Rhode Island, Utah, Virginia, Vermont, and West Virginia. State medical examiners provided information on all drug-related deaths, and CDC analyzed the deaths involving an opioid, whether in combination with other drugs or by itself. Opioid distribution data for these states were available from the ARCOS system and converted to morphine milligram equivalents (MME) using a standard reference.[11]

Comparison of methadone to other major opioids in DAWN data was based on rates of death per 100 kg of opioid analgesic in MME. Drug-specific rates were compared using rate ratios and 95% confidence intervals with the rates for methadone as the referents.

*Information about the DEA's ARCOS system is available at
Information about the DAWN Medical Examiner system is available at


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